title: Adherence to single-pill combination versus multiple-pill combination lipid-modifying therapy among patients with mixed dyslipidemia in a managed care population.
abstract: BACKGROUND
  Suboptimal adherence to lipid-lowering therapies is associated with and potentially contributes to increased cardiovascular morbidity and mortality. Single-pill combination (SPC) lipid-modifying therapies may improve patient adherence due to decreased pill burden and increased convenience for the patient.
  
  
  OBJECTIVE
  To compare adherence to SPC versus multi-pill combination (MPC) lipid-modifying medications.
  
  
  METHODS
  This retrospective study used pharmacy and medical claims and laboratory result data from a national managed care dataset to evaluate patients who were newly prescribed simvastatin plus ezetimibe, simvastatin plus niacin, and lovastatin plus niacin either as SPC or MPC. Patients were considered adherent to therapy if they had a proportion of days covered (PDC) ≥ 0.80.
  
  
  RESULTS
  The mean PDC was 0.76 and 0.70 in the first 3 months of therapy, 0.54 and 0.45 in the second 3 months, and 0.50 and 0.41 for the remaining 30 months of follow-up for the SPC and MPC groups, respectively. SPC patients were 32% (OR = 1.32; 95% CI: 1.27-1.36; P < 0.01) more likely to be adherent to treatment than MPC patients.
  
  
  CONCLUSIONS
  Adherence was significantly higher among patients receiving SPC than MPC. Although only associations and not temporality were assessed due to the observational design of this study, the use of SPC may be a successful method for improving adherence in a real-world setting.
authors.affiliation: HealthCore, Inc., Wilmington, DE, USA. skamat@healthcore.com
authors.forename: Siddhesh A
authors.initials: SA
authors.lastname: Kamat
authors.forename: Michael F
authors.initials: MF
authors.lastname: Bullano
authors.forename: Chun-Lan
authors.initials: CL
authors.lastname: Chang
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Gandhi
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Cziraky
mesh_terms: D000368:Aged; D000924:Anticholesteremic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001384:Azetidines / Q000008:administration & dosage* / Q000009:adverse effects; D016208:Databases, Factual; D050171:Dyslipidemias / Q000188:drug therapy*; D000069438:Ezetimibe; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008148:Lovastatin / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009525:Niacin / Q000008:administration & dosage* / Q000009:adverse effects; D010349:Patient Compliance; D012189:Retrospective Studies; D019821:Simvastatin / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors
chemical_list: D000924:Anticholesteremic Agents; D001384:Azetidines; D009525:Niacin; D008148:Lovastatin; D019821:Simvastatin; D000069438:Ezetimibe